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Dr. Bob is Robert Hsiung, MD,
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Posted by g_g_g_unit on December 11, 2013, at 4:04:48
In reply to Akineton » g_g_g_unit, posted by ed_uk2010 on December 10, 2013, at 14:32:22
> Can be taken once or twice a day, depending on response. Half lives vary between individuals so perhaps it was wrong of me to suggest that the timing of the dose won't matter after a few days.
Ah, maybe I'll experiment with taking it in the morning if the need arises.
>
> Yes, I believe it is a weak DRI.I wonder why Australia hasn't regulated it *eyeroll*
>Would it be worth trying a different >anticholinergic? In Aus you have benzhexol >Artane) and biperiden (Akineton). Artane has a >reputation for being stimulating. Biperiden >might be more suitable.
Thanks, I'll make a note if Biperiden! I did notice some of the symptoms returning since stopping the Cogentin last night, though not as forcefully. I'll see how it goes the next couple of days. My sleep was better last night, though.
>
> Have you tried the atenolol yet?Not yet, I was going to see what happens over the next two days.
Thanks for all your help, ed! I really do appreciate it.
Posted by ed_uk2010 on December 12, 2013, at 15:06:01
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 11, 2013, at 4:04:48
>I wonder why Australia hasn't regulated it *eyeroll*
It's too nasty!
>I did notice some of the symptoms returning since stopping the Cogentin last night, though not as forcefully. I'll see how it goes the next couple of days. My sleep was better last night, though.
I think your symptoms will be improving spontaneously now anyway. Have you tried half your previous dose of Cogentin, taken in the AM?
>Have you tried the atenolol yet?
>
> Not yet, I was going to see what happens over the next two days.It might help, but I suspect not, it penetrates into the brain only to a very limited extent. To be honest, I think you'll improve without it. As a result, you probably won't need to try biperiden either.
>Thanks for all your help, ed! I really do appreciate it.
:)
Posted by g_g_g_unit on December 13, 2013, at 1:12:33
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 12, 2013, at 15:06:01
> I think your symptoms will be improving spontaneously now anyway. Have you tried half your previous dose of Cogentin, taken in the AM?
>No, not yet. I was considering it but thought 0.25mg would be too little to have an effect. Maybe I'll try it tomorrow.
The hardest thing is not being overcome by anger and frustration, since I can't believe I've spent 3 weeks like this. I can't even distract myself because reading or watching TV is impossible.I would guess my symptoms are at like a 5/10 now, whereas they were at a 7 when I first posted, so at least that's something.
Posted by ed_uk2010 on December 13, 2013, at 14:29:52
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 13, 2013, at 1:12:33
>I was considering it but thought 0.25mg would be too little to have an effect. Maybe I'll try it tomorrow.
I would if I were you. Cogentin is pretty potent stuff. You could try 0.25mg and repeat it later in the day if needed.
> The hardest thing is not being overcome by anger and frustration, since I can't believe I've spent 3 weeks like this.
Just keep reminding yourself, it WILL come to an end. Unfortunately, the interim period will be unpleasant, as you well know.
Posted by ed_uk2010 on December 13, 2013, at 14:35:13
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 13, 2013, at 1:12:33
>I can't even distract myself because reading or watching TV is impossible.
Can you return to your doctor soon? I still think diazepam and metoprolol could be beneficial as a temporary measure. I do not entirely understand the logical behind prescribing the very hydrophilic atenolol, which is known for its reduced effects on the central nervous system. You should try it though.
As far as distractions, have you watched any comedy clips on YouTube? Brief and funny, you don't have to concentrate much or stay still for long.
ed
Posted by g_g_g_unit on December 14, 2013, at 8:12:15
In reply to Re: Cogentin » g_g_g_unit, posted by ed_uk2010 on December 13, 2013, at 14:29:52
> I would if I were you. Cogentin is pretty potent stuff. You could try 0.25mg and repeat it later in the day if needed.Will do, ed.
Posted by g_g_g_unit on December 14, 2013, at 8:26:58
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 13, 2013, at 14:35:13
>
> Can you return to your doctor soon? I still think diazepam and metoprolol could be beneficial as a temporary measure. I do not entirely understand the logical behind prescribing the very hydrophilic atenolol, which is known for its reduced effects on the central nervous system. You should try it though.I guess some GPs might not know which beta-blockers are specifically indicated for akathisia, and I couldn't recall if atenolol was suitable or not. I things aren't better by next Friday, and the lower dose of cogentin doesn't help, I'll make another appointment.
It was too late to start the cogentin this afternoon so I caved and bought a codeine/paracetemol mix. It helped quite significantly, of course, and eased anxiety/depression to boot, but I'm aware of course that it shouldn't be used regularly.
>
> As far as distractions, have you watched any comedy clips on YouTube? Brief and funny, you don't have to concentrate much or stay still for long.
>Yes, that's kind of what I've been doing anyway. Which comedians do you like?
Posted by ed_uk2010 on December 15, 2013, at 9:55:35
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 14, 2013, at 8:26:58
>I caved and bought a codeine/paracetemol mix. It helped quite significantly, of course, and eased anxiety/depression to boot...
Ok well take care! It's easy for people to fall into a trap and end up worse off than they were to begin with.
How are you today?
Posted by g_g_g_unit on December 15, 2013, at 20:18:18
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 15, 2013, at 9:55:35
> >I caved and bought a codeine/paracetemol mix. It helped quite significantly, of course, and eased anxiety/depression to boot...
>
> Ok well take care! It's easy for people to fall into a trap and end up worse off than they were to begin with.Oh, no, it was just a one-off thing, since I was feeling particularly bad that evening .. my stomach is far too sensitive to take painkillers regularly.
>
> How are you today?Not great. My anxiety levels seem to be best when not taking anything, but the symptoms are still there.
Posted by ed_uk2010 on December 16, 2013, at 15:47:03
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 15, 2013, at 20:18:18
>Not great. My anxiety levels seem to be best when not taking anything, but the symptoms are still there.
Hmm, I think you should consider a couple of weeks of diazepam. It may relieve your anxiety and restlessness. You could add metoprolol if needed.
Sorry to hear you're not feeling better yet. Were you planning on starting a different antidepressant by the way, or any other long-term psych med?
Posted by g_g_g_unit on December 16, 2013, at 20:52:53
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 16, 2013, at 15:47:03
> Hmm, I think you should consider a couple of weeks of diazepam. It may relieve your anxiety and restlessness. You could add metoprolol if needed.I would love to, but I am just a bit skeptical. I've reacted paradoxically to Lorazepam, Xanax and Clonazepam. GABAeric herbs such as lemon balm also increase aggression. I thought the odds were that Valium would do the same -- my journal notes aren't very clearly on the matter, 2.5mg seemed to sedate me but not relieve my anxiety.
>
> Sorry to hear you're not feeling better yet. Were you planning on starting a different antidepressant by the way, or any other long-term psych med?
>I have a script for Cymbalta, which my doctor wanted me to try. After this, though, I'll probably take a break for the holidays at least.
Posted by g_g_g_unit on December 17, 2013, at 2:08:42
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 16, 2013, at 15:47:03
I've read that Temazepam and possibly Oxazepam are less likely to produce disinhibition.
Posted by ed_uk2010 on December 18, 2013, at 13:58:24
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 16, 2013, at 20:52:53
>My journal notes aren't very clear on the matter, 2.5mg seemed to sedate me but not relieve my anxiety.
It doesn't sound paradoxical at least. Whether it relieves anxiety or not depends rather a lot on the type of anxiety. It sounds like you're in a different situation at the moment.
I don't understand how payment for prescriptions works in Australia. Can you get inexpensive prescriptions for small quantities of meds, to try them? I do know that most prescription meds are dramatically more expensive in Aus than in the UK.
Posted by g_g_g_unit on December 19, 2013, at 7:06:45
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 18, 2013, at 13:58:24
>
> I don't understand how payment for prescriptions works in Australia. Can you get inexpensive prescriptions for small quantities of meds, to try them? I do know that most prescription meds are dramatically more expensive in Aus than in the UK.Prescriptions are expensive here, particularly because I'm not a permanent resident and therefore not eligible for subsidies.
I saw my family friend today and he gave me a prescription for Oxazepam and clonidine. I'll try the Oxazepam first; I know clonidine works, at least, but it's expensive and quite messy in its effect (depressing, sedating, stimulating).
Posted by ed_uk2010 on December 20, 2013, at 15:22:54
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 19, 2013, at 7:06:45
>Prescriptions are expensive here, particularly because I'm not a permanent resident and therefore not eligible for subsidies.
Someone once told me that for small quantities of inexpensive meds, private prescriptions could be cheaper than NHS prescriptions in Australia. Apparently, your Rx-only meds are (on average) about 14 times more expensive than ours.
>I'll try the Oxazepam first.
Did it help? It has a reputation for low potency. It lasts for a few hours, but is not rapidly absorbed so you're unlikely to feel a sudden effect shortly after taking the dose. Of course, your milage may vary ;)
Posted by g_g_g_unit on December 22, 2013, at 4:04:53
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 20, 2013, at 15:22:54
> Someone once told me that for small quantities of inexpensive meds, private prescriptions could be cheaper than NHS prescriptions in Australia. Apparently, your Rx-only meds are (on average) about 14 times more expensive than ours.
>Thanks, I'll keep that in mind.
> >I'll try the Oxazepam first.
>
> Did it help? It has a reputation for low potency. It lasts for a few hours, but is not rapidly absorbed so you're unlikely to feel a sudden effect shortly after taking the dose. Of course, your milage may vary ;)
>No, I tried 15mg and didn't notice a thing. clonidine (0.025mg) helps the akathisia, but is too stimulating otherwise. This is becoming such a nightmare.
Posted by ed_uk2010 on December 22, 2013, at 5:52:23
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 22, 2013, at 4:04:53
>No, I tried 15mg and didn't notice a thing.
That is (in my impression) typical! I think it's time to try something like metoprolol.
How do you actually feel right now? Can you describe it in detail?
Posted by g_g_g_unit on December 22, 2013, at 7:26:04
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 22, 2013, at 5:52:23
> That is (in my impression) typical! I think it's time to try something like metoprolol.
>
> How do you actually feel right now? Can you describe it in detail?
>Well, with the clonidine, I feel this inner sense of stability .. I guess like I'm adequately stimulated. However, that's accompanied by a slight sense of dissociation, a very choppy/broken attention span and working memory, muscle tension and physical compulsiveness, such as a need to constantly check my phone, email etc. I am more sensitive to noisy, irritable and feel overstimulated. Crudely, it feels like 'too much NE', and is something I have experienced on drugs like Strattera before.
Without the clonidine, there is a sense of inner 'brokenness' and this overwhelming urge to keep moving. It's difficult to describe, but I feel like something is forcing me to move .. and if I don't there is this visceral sense that something will happen. If I am confined to a car, the inner pressure builds up and I have to express it in anyway, by playing with the radio dials, moving my legs etc. I can control it for a certain amount of time, but eventually I have to get out and move.
My jaw will feel rigid and locked, which is different to the kind of jaw tension I get on stimulants. My hands tremble slightly.
I suffer from baseline anxiety/depression anyway, and in the restless state my thoughts have felt more scattered and my attention is poor.. however, there is also a fear/phobia surrounding the inner restlessness, and the thought of trying to do things which require focus (such as writing an email) become very threatening. Often, the easiest thing to do is lie down and hug a pillow, but I do have to change position frequently. I suppose the mental component is almost as bad, or worse than the restlessness.
I sometimes use AskExpert and write to Ivan Goldberg, who is very good. I spoke to another psychiatrist there, as Dr Goldberg is away, and he said Mirtazapine has no association with akathisia and my symptoms sound like agitated depression. However, my thoughts are scattered, rather than racing, and I have never experienced anything like this before, despite years of depression/anxiety and strange states.
Posted by ed_uk2010 on December 22, 2013, at 10:15:20
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 22, 2013, at 7:26:04
>Well, with the clonidine, I feel this inner sense of stability .. I guess like I'm adequately stimulated. However, that's accompanied by a slight sense of dissociation, a very choppy/broken attention span and working memory, muscle tension and physical compulsiveness, such as a need to constantly check my phone, email etc. I am more sensitive to noisy, irritable and feel overstimulated.
Do these effects depend on the dose? What range of doses have you tried?
>Without the clonidine, there is a sense of inner 'brokenness' and this overwhelming urge to keep moving. It's difficult to describe, but I feel like something is forcing me to move .. and if I don't there is this visceral sense that something will happen. If I am confined to a car, the inner pressure builds up and I have to express it in anyway, by playing with the radio dials, moving my legs etc. I can control it for a certain amount of time, but eventually I have to get out and move.
>
> My jaw will feel rigid and locked, which is different to the kind of jaw tension I get on stimulants. My hands tremble slightly.
>
> I suffer from baseline anxiety/depression anyway, and in the restless state my thoughts have felt more scattered and my attention is poor.. however, there is also a fear/phobia surrounding the inner restlessness, and the thought of trying to do things which require focus (such as writing an email) become very threatening. Often, the easiest thing to do is lie down and hug a pillow, but I do have to change position frequently. I suppose the mental component is almost as bad, or worse than the restlessness.
>
> I sometimes use AskExpert and write to Ivan Goldberg, who is very good. I spoke to another psychiatrist there, as Dr Goldberg is away, and he said Mirtazapine has no association with akathisia and my symptoms sound like agitated depression. However, my thoughts are scattered, rather than racing, and I have never experienced anything like this before, despite years of depression/anxiety and strange states.I must admit that I've never heard of these symptoms occuring before when coming off mirtazapine, so I don't know whether it is some kind of uncommon withdrawal reaction or something unrelated. How did you feel before you stopped mirtazapine in the first place? I've heard of pts experiencing an akathisia-like state while on mirtazapine, but not on stopping. Having said that, the fact you've never experienced similar symptoms before does suggest a link between your current state and stopping mirtazapine. Psychomotor agitation has been reported on stopping ADs in general, so it does seem plausible.
I was wondering about Cymbalta, which I think your doctor suggested, and whether it might make you feel more restless initially (although not in the long term). Perhaps a more sedating AD would be appropriate right now. Have you ever taken any tricyclic antidepressants?
Posted by ed_uk2010 on December 22, 2013, at 10:18:36
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 22, 2013, at 4:04:53
Oh, and did you try oxazepam 30mg? It might help, but diazepam is more likely to relax your muscles and jaw.
Posted by g_g_g_unit on December 22, 2013, at 10:38:39
In reply to Re: Akineton » g_g_g_unit, posted by ed_uk2010 on December 22, 2013, at 10:15:20
>
> Do these effects depend on the dose? What range of doses have you tried?I was being careful and trying just 0.025mg. I get a nice, sedating effect, and then tolerance develops in a day. Higher doses sedate me at first, then just made me more stimulated.
> I must admit that I've never heard of these symptoms occuring before when coming off mirtazapine, so I don't know whether it is some kind of uncommon withdrawal reaction or something unrelated.
I do tend to be exceedingly sensitive to medication, so who knows.
>How did you feel before you stopped mirtazapine >in the first place? I've heard of pts >experiencing an akathisia-like state while on >mirtazapine, but not on stopping.
It was hard finding a 'sweet spot'. Anything around 7.5mg+ actually gave me akathisia. The dose I was taking (3mg) boosted my mood, enjoyment etc. and was mildly stimulating in a pleasant way. However, it may have made anxiety subtly worse, and I overslept/gained too much weight, so stopped.
>Having said >that, the fact you've never >experienced similar >symptoms before does suggest >a link between your >current state and stopping >mirtazapine. >Psychomotor agitation has been >reported on >stopping ADs in general, so it does >seem >plausible.Yeah, the dystonic-like jaw stiffness and restless legs are something I don't experience while depressed.
> I was wondering about Cymbalta, which I think your doctor suggested, and whether it might make you feel more restless initially (although not in the long term). Perhaps a more sedating AD would be appropriate right now. Have you ever taken any tricyclic antidepressants?
Yes, I don't think Cymbalta will be a good fit, based on past experience, since anything NEergic tends to be bad for me. The 2 days I tried Cymbalta certainly intensified the restlessness.
I have tried clomipramine, which I reacted horribly too -- anxiety, restlessness, agitation. A low dose of nortriptyline (20mg) was prescribed for sleep, which it didn't help, but ended up improving ADHD. Amitriptyline is hit and miss -- it used to help sleep, but would feel a little stimulating during the day; however, my antihistamine tolerance grew so high this year that low doses did nothing.
Posted by ed_uk2010 on December 22, 2013, at 11:27:18
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 22, 2013, at 10:38:39
It seems that standard antidepressants do not suit you well. I know it's old school but have you tried dothiepin? Some docs don't prescribe it because it's dangerous in overdose, but your doctor gave you amitriptyline - so this can't be too much of a concern! There's also doxepin, but although it's a potent antihistamine, I'm unsure how well it works as an AD.
I wonder whether any of the so-called mood stabilisers would reduce your agitation/restless eg. carbamazepine.
Shame that psychiatry is basically trial and error....
I sent you a babblemail btw.
Posted by ed_uk2010 on December 30, 2013, at 13:50:33
In reply to Re: Akineton » ed_uk2010, posted by g_g_g_unit on December 22, 2013, at 10:38:39
Hi GGG,
I sent you a babblemail.
Posted by lazylizard on January 2, 2014, at 0:25:07
In reply to Re: how did I induce akathisia? » g_g_g_unit, posted by g_g_g_unit on December 10, 2013, at 0:56:36
You can try n-acetyl-l-cysteine and vit B6 for akathisia. Let me know if you do and if it works.
Posted by g_g_g_unit on January 12, 2014, at 7:49:56
In reply to Re: how did I induce akathisia?, posted by lazylizard on January 2, 2014, at 0:25:07
Thanks Ladylizard. I tried B6 and didn't notice much, but maybe I'll give it another shot. NAC makes me more agitated.
This is the end of the thread.
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